THE IMPACT OF HOME HEALTH CARE UTILIZATION ON SUBSEQUENT HOSPICE USE AMONG MEDICARE BENEFICIARIES

Abstract Home health care may increase the use of hospice among Medicare beneficiaries by providing improved access to care, enhanced care coordination, and earlier identification of the need for hospice. This study evaluated home health care use during the last three years of life as a predictor of death in the care of hospice for a cohort of 2,169,496 Medicare beneficiaries who died in 2019. The cohort included beneficiaries continuously enrolled in Medicare for 5 or more years, aged 40 and older, and living in the U.S. fifty states, District of Columbia, U.S. Virgin Islands, or Puerto Rico at death. Co-variates included acute hospitalizations during the look-back period, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. Overall, 46% of beneficiaries used home health care during the lookback period, and 62% died at home. Among beneficiaries who used home health care, 59% died in the care of hospice, compared to 45% who never used home health care. Beneficiaries who received home health care at any point during the lookback period were more likely to later die at home (OR 1.10) or in the care of hospice (OR 1.07) compared to their counterparts without a history of using home health care. Additionally, persons with dementia had greater odds of home death (OR 1.21) and death with hospice (OR 1.68) compared to their counterparts without dementia. This study provides strong evidence of the value of home health care as a strategy to improve end-of-life care quality for Medicare beneficiaries.


INTERGENERATIONAL CONTACT AND THE BENEFITS FOR OLDER ADULTS
Chair: Xin Zhang Co-Chair: Wanyu Xi Discussant: David Weiss Intergenerational contact can be in a variety of forms, from day-to-day interaction between family members, such as filial piety expressed by the younger generation, to artificial contact in an on-line game context.No matter what form of intergenerational contact, it is believed that such contact should be beneficial for older adults for many reasons.For example, it can help to reduce feelings of loneliness, stress and provide a greater sense of purpose.It can also help to foster a greater appreciation for differences between generations and create stronger social connections with those of different ages.It can also boost mental health, physical health, and even reduce the risk of depression.In a group of 5 individual presentations, the authors showcased that intergenerational contact could promote life satisfaction in a 5-year-interval (Ayalon & Dikla), reduce ageist attitudes toward older adults in an on-line game context (Xi, Chang, Zhang, & Ayalon), foster positive selfperception of aging (Chang & Zhang; and Tse), as well as enhance health information-seeking behaviors (Zhao, Song, & Song).These results indicated that even from different cultural background (e.g., Chinese or Americans), a positive intergenerational contact, such as providing social support to aged parents, collaborating with partners from different age groups, and even offer kindness actions toward people of a different age group could indeed be beneficial.These studies provided theoretical insights for the intergenerational contact literature, and highlighted important practical implications for potential interventions to facilitate successful aging for older adults.
University, Beijing,Beijing,China (People's Republic),3. Bar Ilan University,Ramat Gan,HaMerkaz,Israel Previous research indicated that online games represent a unique context of intergroup contact but may enhance prejudice toward outgroup players during gameplay.Despite the growing number of older gamers and increasing opportunities of online in-game intergenerational contact, few study have focused on the online in-game intergenerational contact and its effect on ageism.To address such research gap, we designed an online quiz game by manipulating in-game intergenerational contact type (competition vs. cooperation) and game outcome (win vs. loss).148 young participants (Mage = 22.71, SD = 2.88) and 155 older participants (Mage = 65.4,SD = 4.23) were recruited and randomly assigned into the four experimental conditions to play with a virtual game partner of opposite generation.Positive and negative dimensions of age-stereotype perception, individual's cooperative orientation, and potential covariates were measured.Results showed significant intergenerational contact type × outcome × cooperative orientation effects on the perception of negative old-age-stereotype among younger participants and positive young-age-stereotype among older participants.Younger participants showed significant more negative old-age-stereotypes under competition loss (vs.win) condition, but older participants showed significant more positive young-age-stereotypes under cooperation loss (vs.win) condition.The findings indicated the negative impact of intergenerational competition among younger participants in the online game context, and also suggested the internalized self-ageism among older participants.Moreover, the boundary condition of personal factors revealed, that the effects of in-game intergenerational contact were only significant among those of lower (vs.higher) cooperative orientation.Our study also offered practical implications on designing gamified intergenerationalbased intervention.

KINDNESS INTERVENTION AND SELF-PERCEPTION OF AGING: AN INTERGENERATIONAL PERSPECTIVE
Dwight Tse 1 , and Ewan Cahill 2 , 1. University of Strathclyde, Glasgow, Scotland, United Kingdom, 2. Glasgow Caledonian University, Glasgow, Scotland, United Kingdom Performing acts of kindness can enhance benefactors' well-being.However, few studies have examined its impact on older benefactors.This study aimed at evaluating this intervention among older adults and exploring "side benefits" beyond well-being.Specifically, given the negative stereotype on older adults as unproductive and incompetent, we hypothesized that acts of kindness could combat against older adults' internalized negative self-perceptions and enhance their self-concept.We conducted a randomized controlled experiment with 45 participants in the United Kingdom aged 61-80 (73% female).In the experimental condition, for 14 consecutive days, participants recalled up to three acts of kindness they did for others on that day and planned up to three acts of kindness on the next day, as opposed to listing up to three places they were at in the control condition.Surprisingly, our pre-test post-test comparison revealed no significant difference in well-being improvement between the two conditions.
Compared to the control group, the experimental group showed an improvement in attitudes toward own aging, especially for their age-related cognitions in the gain (vs.loss) domain.Beneficiaries were mostly family members (34%), followed by community members (25%) and friends/colleagues (21%).For intergenerational acts of kindness, participants reported similar frequencies of younger and older beneficiaries (compared to their age) and provided predominantly emotional (vs.instrumental) support.Taken together, performing acts of kindness may help older adults counteract negative aging stereotypes and see themselves in a more positive lens as productive and competent members of society.

MORE FILIAL PIETY FROM ADULT CHILDREN, MORE POSITIVE SELF-PERCEPTION OF AGING IN OLDER PARENTS?
Yuanqing Chang, and Xin Zhang, Peking University, Beijing, Beijing, China (People's Republic) Filial piety, as a central concept in Confucianism, is about the ideas of how children should treat their parents.Previous studies on filial piety have focused on older generation's well-being.However, whether filial piety of adult children could influence their parents' selfperception of aging on a longitudinal dyad basis is largely unknown.Drawing on the Dual Filial Piety Model and the intergenerational contact perspective, we investigated the differential impacts of authoritarian vs. reciprocal filial piety of adult children on older parents' self-perception of aging using a longitudinal parent-child dyads dataset from a large population-based survey (i.e., Chinese Longitudinal Healthy Longevity Survey, CLHLS) from wave 2002 to wave 2005.Self-perception of aging of older parents was measured at two time points, authoritarian and reciprocal filial piety of adult children was measured at wave 2002.Latent change score modeling was performed on a 2387 parent-child dyads sample (Mage = 80.03, SD = 9.86 for parent; Mage = 48.54,SD = 8.10 for child) to test our research hypothesis.Results showed only reciprocal filial piety of adult child at wave 2002 could positively predicted their parents' latent change score of self-perception of aging 3 years later, after controlling for potential covariates.Our study suggested that the effects of adult children's filial piety might have different effects on parents' aging attitude, such that a reciprocal parent-child relationship rather than child's submission to parents could improve parents' attitude toward their own aging.

A GENDERED PERSPECTIVE ON INTERGENERATIONAL RELATIONSHIPS IN THE SECOND HALF OF LIFE Liat Ayalon, Bar Ilan University, Ramat Gan, HaMerkaz, Israel
Life satisfaction is defined as the perception of individuals concerning the level of meaning, fulfillment, and satisfaction in their life.It has shown to be an important indicator of older persons' perceived ability to pursue their life goals.The present study evaluated the relationship between older mothers' and fathers' perceptions of their relationship with their children and their life satisfaction four years afterwards.